It is said the heart works in mysterious ways. Unfortunately for Grey, a young and seemingly healthy German short-haired pointer, those mysterious ways were killing him. It would take the collaboration and innovation of experts from across the board to solve this particular puzzle and save Grey’s life.
Several members of the team of experts that worked to get to the bottom of Grey’s mysterious heart condition. Pictured left to right: Heidi Killihan, cardiologist; Ken Waller, radiologist; Sara Colopy, surgeon; Kim Claus, emergency and critical care; Lauren Markovic, cardiology; and James Gedig, Grey’s owner.
Grey was wrestling with his brother when a moment of overexertion left him coughing uncontrollably. The trip to the local veterinarian in Minocqua revealed a shock for Grey’s owner: the problem was with his heart.
“The vet told me, ‘Get this dog to Madison immediately,’” said James Gedig, Grey’s owner. “He was on his last leg.”
When Grey arrived at the UW Veterinary Care Teaching Hospital, he had gone from healthy pup to heart failure in nothing flat. Heidi Kellihan, a veterinary cardiologist at the School of Veterinary Medicine (SVM), and her team recognized the symptoms of a congenital heart defect. Kellihan thought Grey was suffering from a Patent Ductus Arteriosus (PDA), a common birth defect in dogs, but she was in for another surprise. “We went to correct the PDA vessel, and he didn’t have one,” said Kellihan.
In search of more information, Kellihan reached out to her counterparts on the human side of medicine at the UW American Family Children’s Hospital and Wisconsin Institute for Medical Research (WIMR). “We consulted the pediatric cardiologists at the hospital,” said Kellihan. “Their cases and our cases are very similar when it comes to congenital defects.”
This 4-D flow image shows where and how fast blood was flowing in Grey’s heart, with higher speeds highlighted in green. It reveals the vortex effect created by Grey’s unusual defect, with blood spinning quickly through the abnormal vessel.
With the help of the WIMR team, Kellihan took Grey to the human hospital for an advanced MRI scan. Chris Francois, a cardiovascular radiologist at WIMR, explained that they hoped this new imaging technique, called 4-D flow imaging, would reveal more about Grey’s heart. “It allows us to look at 3-D volume and how blood is flowing in the heart,” said Francois. “The technique proved very helpful in figuring out the physiology of Grey’s defect.”
With just a quick scan, Francois and his team had all the data they needed to create a 3-D computer model of Grey’s heart that showed where the blood was flowing within it. The results were surprising.
Grey did indeed have an abnormal vessel but not one that any of the veterinary or pediatric cardiologists had seen before. “This was in a very odd spot,” said Kellihan. “We didn’t know what we were dealing with without all the advanced diagnostic imaging.”
The abnormal vessel connected the aorta with the pulmonary artery, and the 4-D flow image revealed the strange effect on Grey’s heart. “It was creating this huge vortex,” said Kellihan, explaining that the high-tech MRI revealed blood spinning through the abnormal vessel so quickly that it was weakening the vessel walls.
There was no doubt that Grey required surgery, but it would not be easy. Unlike more common congenital defects that Kellihan and Francois see, Grey’s abnormal vessel position made it much more difficult to access surgically.
Dale Bjorling, the veterinary surgeon on the case, had a long and tricky surgery in front of him; the first four hours were spent simply dissecting around to where the defect was located. Even when Bjorling did have access, he did not have a clear view; he had to use other information as a guide.
“Just by touch, we could feel the abnormal flow of the blood from the aorta to the pulmonary artery,” said Bjorling. Kellihan provided additional information by operating a trans-esophageal echo to constantly monitor Grey’s blood flow. “It allowed her to tell us when we were obstructing the flow,” Bjorling explained. “Based on that information, we were able to place sutures from the outside and close off the abnormal flow.”
Grey bounced back from his six-hour surgery with his usual puppy energy, making it hard to believe he ever had a failing heart. According to Kellihan, Grey was playing with his brother again in no time. “He had to be restricted for two weeks, and then he got to be Grey again,” said Kellihan.
The collaborations between human and veterinary, medical and surgical, cutting-edge technique and daily practice that went in to this unusual case saved Grey’s life. But to Kellihan, Francois, and Bjorling, collaboration simply makes sense.
Kellihan explained that her team of veterinary cardiologists makes the trip to the human hospital on a regular basis to present cases. “We talk to them all the time,” said Kellihan. “If we have cases we want their opinion on, we just ask. It’s a really nice collaboration.”
Without this form of open communication, cases like Grey’s might pose a difficult challenge, but instead they offer a learning opportunity for many rather than an obstacle for one.
Ali Bartol
